Active NPI
Elizabeth Scott Community, Inc.
- Skilled Nursing Facility
- Maumee, OH
National Provider Identifier
1629052139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0184
- Legal business name
- ELIZABETH SCOTT COMMUNITY, INC.
- Practice address
- 2720 Albon Rd
Maumee, OH 43537-9752 - Phone
- (419) 865-3002
- Fax
- (419) 865-1283
- NPI assigned
- Nov 30, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert C. Dennie, LNHA
- Title
- Administrator
- Phone
- (419) 724-5156
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0184 | OH | Primary |
Addresses
Primary practice location
2720 Albon Rd
Maumee, OH 43537-9752
Mailing address
2720 Albon Rd
Maumee, OH 43537-9752
Phone (419) 865-3002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2440424 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000292 | OH | Part A Provider - Skilled Nursing Facility | 9032012695 | Practice locations: Maumee, OH |
Skilled nursing facility certification: CCN 366184
- Legal name
- ELIZABETH SCOTT COMMUNITY, INC.
- Doing business as
- ELIZABETH SCOTT COMMUNITY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 8, 1999
- Last certification
- Sep 12, 2024
- Beds
- 60
- Ownership / control type
- Corporation
- Most recent change of ownership
- Jan 1, 2004
- Organization structure
- Corporation
- Incorporated
- Oct 31, 2003 in OH
- Enrollment address
- 2720 Albon Rd
Maumee, OH 43537-9752
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Elizabeth Scott Community
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Dec 8, 1999
- Medicare certification status
- Active
- Certified beds
- 60
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Candace Krabil | Operational/Managerial Control | Jul 16, 2007 | |
| Paul Bucher | Corporate Officer | Feb 28, 2007 | 100% |
| Corporate Director | Feb 28, 2007 | 100% | |
| W-2 Managing Employee | Oct 31, 2003 | ||
| Elizabeth Scott, Inc. | 5% Or Greater Direct Ownership Interest | Oct 31, 2003 | 100% |
| Operational/Managerial Control | Oct 31, 2003 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Toledo, OH
- NPI 1336316306
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1629052139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2720 ALBON RD",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435379752",
"telephone_number": "419-865-3002",
"fax_number": "419-865-1283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 ALBON RD",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435379752",
"telephone_number": "419-865-3002",
"fax_number": "419-865-1283"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELIZABETH SCOTT COMMUNITY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-30",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DENNIE",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "C.",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "419-724-5156",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "LNHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "0184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2440424",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.